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Does the patient require Prophylactic Antibiotic Coverage prior to dental treatment If yes for how long 6 months 1 year 2 years Yes No If no please state reason Oral Regimen you recommend RX DISP SIG 2. Hidy Stavarache of Hidy Stavarache D. D. S. Ltd. I hereby authorize Hidy Stavarache D. D. S. Ltd. to receive and use my protected medical information for the purpose of documenting any and all medical clearance required prior to dental treatment. Hidy Stavarache D. D. S. 9910 W. Cheyenne...

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What is 9910 w?

9910 w is a tax form used to report income earned from self-employment.

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